Billing code 99421: Online E/MMedicare rate & RVUs
Report 99421 for an established patient’s online, asynchronous evaluation and management when the clinician’s cumulative work totals 5–10 minutes over seven days.
Medicare pays $15.70 for 99421 nationally in the office and $11.02 in a hospital or facility. Local office rates run $14.43–$20.01.
Medicare rate · 99421
Online E/M
Swap in your local Medicare rate.
- Work RVUs
- 0.25
- Total RVUs
- 0.47
- Global days
- XXX
National rate · 2026
$15.70
Office setting, before claim adjustments.
See every locality for 99421 → · Billed by an NP, PA or therapist? →
Medicare allowed amount for participating (non-QP) physicians, before deductible, coinsurance and claim adjustments. Not a patient’s bill or a hospital charge.
On this page 10 sections
What 99421 covers
99421 covers a patient-initiated online evaluation and management service for an established patient. A physician or other qualified health care professional may review the patient’s secure portal message, assess the concern, review relevant records, make a management plan, and communicate recommendations or orders electronically. The service is asynchronous; it is not a scheduled video or telephone visit.
Select this level when the clinician’s cumulative time on the online evaluation and management work is 5–10 minutes during the seven-day period. Count the work across the episode rather than reporting separately for each message. Documentation should show the patient’s concern, the clinician’s assessment and management, the communication, and the total time. When the same problem leads to an in-person or other E/M service during the applicable period, the online work is generally included in that E/M service rather than reported separately.
This summary was written with AI assistance from CMS physician fee schedule data and checked against the CMS billing rules shown here. Rates on this page come directly from CMS files.
Where 99421 pays more and less
The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.
109 payment localities
$14.43 to $20.01
109 of 109 payment localities
99421 rates by state
Office rate range in each state. Select a state to see its payment localities.
Explore a state
Local rates. Clear comparisons.
Hover or focus a tile to see its rate range. Select it to open the state’s fee schedule.
$14.43
$20.01
Color shows the midpoint of each state’s locality range.
View every state and territory as a table
| State / territory | Office rate range | Localities |
|---|---|---|
| AK | $20.01 | 1 |
| AL | $14.57 | 1 |
| AR | $14.43 | 1 |
| AZ | $15.40 | 1 |
| CA | $16.17–$19.26 | 29 |
| CO | $16.08 | 1 |
| CT | $16.52 | 1 |
| DC | $17.41 | 1 |
| DE | $15.59 | 1 |
| FL | $15.74–$16.99 | 3 |
| GA | $15.11–$15.96 | 2 |
| GU | $16.33 | 1 |
| HI | $16.33 | 1 |
| IA | $14.73 | 1 |
| ID | $14.81 | 1 |
| IL | $15.49–$16.66 | 4 |
| IN | $14.87 | 1 |
| KS | $14.73 | 1 |
| KY | $14.90 | 1 |
| LA | $14.90–$15.40 | 2 |
| MA | $16.05–$17.26 | 2 |
| MD | $15.81–$17.41 | 3 |
| ME | $14.91–$15.39 | 2 |
| MI | $15.20–$15.92 | 2 |
| MN | $15.42 | 1 |
| MO | $14.76–$15.38 | 3 |
| MS | $14.60 | 1 |
| MT | $15.70 | 1 |
| NC | $15.01 | 1 |
| ND | $15.30 | 1 |
| NE | $14.77 | 1 |
| NH | $15.89 | 1 |
| NJ | $16.71–$17.34 | 2 |
| NM | $15.28 | 1 |
| NV | $15.59 | 1 |
| NY | $15.17–$18.07 | 5 |
| OH | $15.12 | 1 |
| OK | $14.83 | 1 |
| OR | $15.47–$16.40 | 2 |
| PA | $15.11–$16.25 | 2 |
| PR | $15.76 | 1 |
| RI | $16.01 | 1 |
| SC | $15.09 | 1 |
| SD | $15.25 | 1 |
| TN | $14.78 | 1 |
| TX | $15.05–$16.03 | 8 |
| UT | $15.23 | 1 |
| VA | $15.39–$17.41 | 2 |
| VI | $15.76 | 1 |
| VT | $15.30 | 1 |
| WA | $16.00–$17.51 | 2 |
| WI | $14.96 | 1 |
| WV | $15.11 | 1 |
| WY | $15.52 | 1 |
How the 99421 rate is calculated
Each of 99421’s three RVUs is multiplied by a geographic index (GPCI) for the payment locality, added up, and multiplied by the conversion factor. Drag the indexes or enter a ZIP to see what moves the rate.
How the rate is built · 99421
RVUs × geographic indexes × conversion factor
Swap in your local Medicare rate.
Work 0.25Practice expense 0.20Malpractice 0.02
All indexes start at 1.000 (the national rate). Enter a ZIP or drag a slider.
Payment rules and modifiers for 99421
99421 has no global surgery period, no multiple-procedure, bilateral or assistant-at-surgery adjustment, and no professional/technical split. What changes the payment is where the service happens: the place of service on the claim decides whether Medicare pays the office or the facility rate.
Place of service · 99421
Which rate does Medicare pay?
The POS code on the claim line (CMS-1500 box 24B).
Non-facility (office) rate · national
$15.70
The facility rate would be $11.02 (+$4.68). In a facility, the facility bills its own costs separately.
99421 compared with similar codes
Compare codes
99421 vs 99422 vs 99423: national Medicare rates
Swap in your local Medicare rate.
How to choose
99421 billing questions
When should 99421 be chosen over 99422 or 99423?
Use 99421 when cumulative online E/M time is 5–10 minutes over seven days. The higher-level codes are for longer time: 11–20 minutes for 99422 and 21 minutes or more for 99423.
Can each portal message be reported as a separate unit?
No. Combine the clinician’s time for the online E/M work over the seven-day period and report the applicable level once for that episode.
What documentation supports 99421?
Document the established patient’s online concern, the clinician’s evaluation and management, the response or plan, and cumulative time for the seven-day period.
Does 99421 describe a video visit?
No. It describes asynchronous online E/M work, such as review and response through a secure patient portal; it is not a synchronous video encounter.
How does 99421 differ from G2012?
99421 captures a broader online evaluation and management episode with cumulative work over seven days. G2012 describes a brief communication technology-based check-in.
Where these rates come from
FeeBase calculates base physician payments from CMS work, practice-expense and malpractice RVUs, adjusted by each locality’s geographic indexes and the conversion factor. Services without a published rate are labeled, never given a made-up amount. Amounts are Medicare allowed amounts before claim adjustments: not a patient’s bill or a commercial rate.
CMS RVU26D · effective Oct 1, 2026 through the day before Jan 1, 2027
Show the CMS file lines behind this rate
Fee sheets
Put 99421 and the rest of your codes on one sheet
Build a fee sheet from your own code list at your locality, put your payer contracts beside Medicare, and see what changed each quarter.
Build my fee sheetOr price your code list free →